Shotguns for the Suicidal?
The field of mental health has, to me, always been a profession where we help people to both learn to help themselves and protect them from harm, so it was with a degree of both dismay and incredulity that I saw an article in The Sunday Times of London, February 5, 2006.
It seems that a debate among nurses in Great Britain will be taking place shortly and that's something I would have missed if it weren't for the topic to be discussed: giving blades to self-harmers. My thinking is that would be tantamount to advocating for shotguns for the suicidal. I don't intend to sound like I'm taking this lightly, I can assure you.
One of the nurses interviewed stated that self-harm patients (aka those who engage in SIB or Self-Injurious Behavior) need clean, sterile blades for their cutting rather than razor blades, dirty knives, broken glass or tin cans. This poses another question in my mind: Do SIB patients intend to cause flesh injuries or start an infection that could endanger their lives? I don't believe they do intend to cause an infection and it is unlikely that they would choose particularly dirty implements. The few SIB patients I saw in the hospital all used clean, new razor blades or kitchen knives. All of them let other patients and staff know they had cut themselves and were given immediate medical care.
The rational also used to advance this proposal is that we provide clean needles for drug addicts, so why not clean blades for SIB patients? I do see a connection, but it's a bit beyond my reach to explain in terms of the neurobiology behind it. SIB patients may, in some way, be addicted to this behavior. We do know that, when interviewed about why they cut themselves, they will say because it makes them feel better and they have a sense of relief after the cutting. I once saw a woman who had so many cuts on her arms that both of them were covered in straight white welts from just above her wrists to the beginning of her shoulders.
One advocate not only favors the clean "sharps," but believes it would be a good idea to sit there as the patient carves away.
Now, I come to yet another question: Is or isn't SIB a form of mental disorder and can a person with such a disorder make a rational judgment about their safety? The question of civil liberties has been brought into this discussion here in the US where patients are seen as having a right not to take medication or accept treatment, unless they are deemed a danger to themselves or others. Unless someone makes that determination, they can do as they please.
What do you think?